Healthcare Provider Details

I. General information

NPI: 1790565521
Provider Name (Legal Business Name): NORTH MISSISSIPPI MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 09/29/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 SOUTHRIDGE DR
TUPELO MS
38801-6478
US

IV. Provider business mailing address

808 VARSITY DR
TUPELO MS
38801-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-407-0801
  • Fax: 662-407-0807
Mailing address:
  • Phone: 662-377-2774
  • Fax: 662-377-2057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRUCE TOPPIN
Title or Position: CORPORATE SECRETARY
Credential:
Phone: 662-377-4229